Quality of Life in an Adolescent Orthodontic Population: Invisalign® versus Fixed Appliances By Richa Sharma A Thesis Submitted to The Faculty of Graduate Studies of The University of Manitoba in partial fulfilment of the requirements of the degree of MASTER OF SCIENCE Department of Preventive Dental Science Dr. Gerald Niznick College of Dentistry Rady Faculty of Health Sciences University of Manitoba Winnipeg, Manitoba, Canada Copyright© 2020 Richa Sharma 1 Acknowledgments This study was supported by the Dr. Gerald Niznick College of Dentistry Endowment Fund. A sincere thank you to: My supervisor, Dr. Robert Drummond, for being an approachable, supportive, and dedicated mentor throughout my studies. My committee members, Dr. Robert Schroth, and Professor Mary Bertone for their guidance and support. Dr. Milos Lekic for his assistance with the study design and data collection, as well as for his mentorship. Dr. Robert Tate for not only the statistical analysis, but also for his time, encouragement, and dedication to my thesis. 2 Table of Contents Abstract: ........................................................................................................................................... 6 Chapter 1: Introduction and Review of the Literature ............................................................... 7 Background on Fixed Appliances and Invisalign® ........................................................................ 7 Adolescents .................................................................................................................................... 8 Malocclusion .................................................................................................................................. 9 Concept of Oral Health-Related Quality of Life ......................................................................... 10 Quality of Life Measures ............................................................................................................. 11 Indices of Treatment Need ........................................................................................................... 12 Perceived Need ............................................................................................................................ 13 Expectations ................................................................................................................................. 14 Satisfaction ................................................................................................................................... 15 Motivation for Treatment ............................................................................................................. 17 Impact of Malocclusion on Emotional and Psychosocial Well-Being ...................................... 21 Bullying ........................................................................................................................................ 23 Oral Health and Functional Impact of Malocclusion .................................................................. 24 Impact of Orthodontic Treatment on OHRQOL ......................................................................... 26 Impact of Orthodontic Treatment in Fixed Appliances or Invisalign® ....................................... 26 Psychosocial Impact of Fixed Appliances ................................................................................... 27 Functional Impact of Fixed Appliances ....................................................................................... 28 Oral Health Impact of Fixed Appliances ..................................................................................... 34 Impact of Invisalign® on OHRQOL ............................................................................................ 35 Studies Comparing Fixed Appliances and Invisalign® ............................................................... 37 Purpose ......................................................................................................................................... 42 General Objective ........................................................................................................................ 43 Null Hypotheses ........................................................................................................................... 43 Chapter 2: Materials and Methods: ............................................................................................. 44 Study Sample ............................................................................................................................... 44 Inclusion Criteria ......................................................................................................................... 44 Exclusion Criteria ........................................................................................................................ 44 Case Selection and Recruitment .................................................................................................. 45 Study Questionnaire ..................................................................................................................... 46 Satisfaction Measurement ............................................................................................................ 48 Statistical Analysis ........................................................................................................................ 48 Test Groups .................................................................................................................................. 49 Chapter 3: Results: ........................................................................................................................ 50 Demographic Data ......................................................................................................................... 50 Findings ........................................................................................................................................ 54 Chapter 4: Discussion .................................................................................................................... 61 Clinical Significance .................................................................................................................... 75 Considerations and Limitations ................................................................................................... 75 Future Recommendations ............................................................................................................ 77 3 Chapter 5: Conclusion ................................................................................................................... 78 Revisiting the Null Hypotheses: .................................................................................................. 78 References ....................................................................................................................................... 80 Appendices ...................................................................................................................................... 92 Appendix 1 ................................................................................................................................. 93 Appendix 2 ................................................................................................................................. 94 Appendix 3 ................................................................................................................................. 95 Appendix 4 ................................................................................................................................. 96 Appendix 5 ................................................................................................................................. 97 Appendix 6 ................................................................................................................................. 99 Appendix 7 ................................................................................................................................. 100 Appendix 8 ................................................................................................................................. 105 Appendix 9 ................................................................................................................................. 122 List of Tables Table 1: Demographic Data ........................................................................................................ 50 Table 2: Summary of responses: All participants ....................................................................... 51 Table 3: Summary of significant results from each test group .................................................... 53 Table 4: Detailed summary of significant results from each test group ..................................... 53 Table 5: Summary of COHIP-19 Scores: Fixed Appliances Vs. Invisalign (All participants) ... 58 Table 6: Summary of quality of life, satisfaction and domain scores among all test groups ...... 59 Table 7: Summary of significant correlations (Fixed Appliances, All participants) ................... 60 Table 8: Summary of significant correlations (Invisalign®, All participants) ............................. 60 List of Figures Figure 1: Comparison of satisfaction scores (All participants) ................................................... 56 Figure 2: Comparison of COHIP-19 mean domain